Detecting and treating breast cancer

Funding and facilities sometimes present challenges in Routt County

Few people are more familiar with the effects of breast cancer than 32-year-old Julie Brown, 32.

Brown's mother was diagnosed at 38 and died at 42; the disease claimed her sister at 32 in 1998. Almost two years ago, in September 1999, she too was diagnosed with breast cancer.

She was too young to qualify for financial assistance programs and the cancer had just started to spread by the time she was diagnosed. Still, in some ways, Brown was lucky. Constantly surrounded by the shadow of breast cancer, Brown knew the warning signs, she knew what to look for, and was more informed than most women.

"The more education, the better," Brown said. "I think to have it out there more often than not is better. Don't be afraid if you find something. It's not always cancer."

But sometimes it is. The recently released study "Cancer in Colorado" shows that nearly one in seven women will develop breast cancer. The report showed Coloradans were diagnosed with cancer at a lower rate from 1993 to 1997 than the rest of the nation, and that breast cancer deaths dropped 13 percent during that same time and another 12 percent by 1998. Breast cancer was being discovered at a higher rate in Anglo women, but Jillian Jacobellis of the Colorado Department of Public Health and Environment attributed the rise to an increase in screening and early detection.

Locally, Routt County exhibited a higher incidence and mortality rate than the state from 1997 to 1998. Twenty-four women were diagnosed with cancer that year, six more than the period from 1995 to 1996. Five women died in each time period. Nearby Moffat County had 16 cases total for both those periods combined, reporting less than three deaths each time.

There are issues that Routt County women face in terms of treatment and diagnosis of breast cancer face. Funding changes have made it difficult for women under age 50 to have mammograms performed here and the lack of available facilities almost ensures that locals diagnosed with breast cancer will have to travel to Denver for treatment.

Getting screened

In 1996, Char Opper, then 41, and her sister Lisa Fockler, 31, were both diagnosed with breast cancer.

A Planned Parenthood program that paid for examinations and an all-important mammogram helped the detection process. Today, the program wouldn't have paid for the mammogram and the cancer in Opper and Fockler may not have been discovered.

The Colorado Women's Cancer Control Initiative (CWCCI), a state grant that offers free services to women who qualify, provides a free breast exam and pelvic exam and Pap test for women aged 40 to 49; women 50 and older receive the significant bonus of a mammogram.

"This is a wonderful grant that we receive and many women have used it," said Amy Dickson of Planned Parenthood of the Rocky Mountains. "But as you can see, for women under 50 that need a mammogram, there really is no funding that we have."

Mammograms take X-ray pictures of the breast and can find the smallest hints of cancer hints that might otherwise take up to two years to detect through a physical exam.

The Yampa Valley Medical Center is the only place in town that offers mammograms other than the Craig Memorial Hospital. But the price tag for such testing when cancer is not already suspected can be out of reach of many women.

The local Planned Parenthood organization can help out in terms of the breast exam and Pap smear, which can cost up to $100. A routine screening diagram, the type women are advised to get annually, is an $85 dollar service that includes the radiologist's reading fee and a minimum number of views.

A diagnostic mammogram for something that is already suspected comes at an even higher price.

"It's important for them to change the guidelines," Opper said. "Not covering mammograms until they're later in their 40s is putting women at risk."

From 1994 to 1998, the incidence of cancer for women in Colorado more than doubled once they reached the ages of 40 to 44, making the need for early detection more important. From 1997 to 1998, Routt County diagnosed 30 cases of breast cancer, but only 59.3 percent were detected at the earliest possible stage. Colorado as a whole detected 72.8 percent of 6,147 cases at an early stage in the same period. Moffat County detected all eight cases early, a huge step from when they detected 62.5 percent of nine cases from 1995 to 1996.

Most of the women Dickson encounters at Planned Parenthood aren't even aware programs are available to help out with the financial aspect. Many are under-insured because of the area's high cost of living and the seasonal nature of most jobs, according to Dickson.

"It really does show a need for low-cost reproductive health care," Dickson said. "They put off their health because they've got other bills to pay."

Both Planned Parenthood and the Visiting Nurse Association clinic in Craig receive CWCCI funding, as well as government funding through Title X. Title X is aimed more at family planning issues, but does give assistance in terms of a complete physical and breast exam.

Planned Parenthood received funding in late March to help out 310 Routt County citizens who qualified. Already, 158 of those slots have been taken.

"We've already caught a couple of women and referred them to get a second opinion on it," Dickson said.

Dickson said a lack of funding may explain why mammograms for women younger than 50 has been removed this year.

Opper and her sister will share their anniversaries as five-year survivors of breast cancer this year. They will soon head to Seattle for the Avon three-day walk, hoping to raise $5,000 for breast cancer awareness.

Treatment Facilities

Peggy Filer's tumor was small enough that she had the option to have a lumpectomy -- a surgical procedure that removes the tumor with minimal damage to the surrounding tissues -- instead of a mastectomy, where the entire breast is removed. Then 55, she felt that a lumpectomy would be much less severe than a mastectomy, even though she would have to undergo extended radiation treatments.

There was one problem. Chemotherapy was available at the Yampa Valley Medical Center but the area had did not have the necessary radiation facilities. Filer, 61, had to rent an apartment in Denver for five weeks to get the treatment she needed.

"I've often wondered if we had radiation treatments here in Steamboat if more women would opt for a lumpectomy instead of a mastectomy," Filer said. "For many women in Steamboat, they're not financially able to do that, or they feel like they can't because of a family obligation."

Carol Milligan, a retired radiation oncologist who used to practice in California, said that from the last reading she had made, the cost of a mastectomy versus a lumpectomy plus the radiation treatments were generally the same, with the lumpectomy option costing slightly more.

So why not create a radiation facility in town? Because it would cost millions, Milligan said.

"It's expensive equipment and by the time you purchase and build the building for it, you can't support it unless you have a certain number of patients," Milligan said. "Around the country, the highest rates of use are in the East Coast and the West Coast or big cities. Rural areas have lower rates of utilization."

The best chances are trips to Denver, Fort Collins or Wyoming for treatment, although Vail is working on such a facility.

Early detection

Jan Fritz, a registered nurse at the Yampa Valley Medical Center, said most patients always show the same fear when they find a lump. More often than not, women find the lumps themselves.

"They are their own best defense," said Fritz, who is extremely active in raising awareness in the community. "The self-breast exam is the prime thing they have to do. Half of the lumps are discovered by the women themselves; you have to do that regularly."

Since more than half of Planned Parenthood's Title X assistance slots have been used, there is an indication that more people are getting examined. And Fritz said the X-ray department reported more people are getting mammograms.

Despite the lack of a radiation facility, most of the survivors praised area doctors and were thankful for the advantage of having a chemotherapy machine readily available. Opper said that drug treatments have improved vastly in terms of handling side effects, such as pain or nausea, and that the availability of stem cell treatments gave more hope to those diagnosed atlate stages.

"In this community, the women who have had (breast cancer) are for the most part very open," Opper said. "That example helps motivate women to be pro-active and have their check-ups and their mammograms."

Planned Parenthood offers numerous informational brochures, including a reminder that hangs from the shower and demonstrates how to conduct a monthly breast exam. The survivors stressed the importance of an annual check-up, in the hopes of getting early detection and prevention.